Prof. Aaron Ojule, the Chief Medical Director of University of Port Harcourt Teaching Hospital (UPTH), was at the centre of the battle against Ebola during the outbreak of the deadly disease in Rivers State last year. He relives his experience, in this exclusive interview with PRECIOUS DIKEWOHA and also speaks about the challenges confronting the health sector in the country, among other issues.
You are in your second tenure as the Chief Medical Director of the University of Port Harcourt Teaching Hospital (UPTH). How would you say you have fared?
I assumed duty on November 9, 2009 and I am in my second tenure as the Chief Medical Director of this hospital. When you talk about my achievements, you should look at the bed capacity of this hospital. Before now, it was 110, but today we have 840 beds. That is because we have added new units and services. It is about 60 per cent increase in bed capacity. We have completed and furnished new paediatrics block. We have also completed and furnished the Nuclear Medicine Building, the male and female dental ward and so many of them.
I have 38 projects which are either completed or ongoing under my administration. Under my administration, the hospital has not lost accreditation for any existing training programme. All departments and programmes due for re-accreditation were successfully re-accredited. They include general surgery, internal medicine, paediadrics and gynaecology.
Some of the projects are capital intensive. Does that mean you are getting more allocation from the Federal Government and other donors?
One thing is to get the fund, another thing is to utilise it properly. There is nothing extraordinary we are doing except that the little money we get from government and the one we generate here, we ensure that it is properly utilised. Also we have been able to attract partners to come and help us to do one or two things in addition. But to a large extent, the money we are using is from the government, but we are able to utilise it.
What other areas do you think you still need government’s assistance?
We believe that the new government will take a critical look at the health sector, because any big public hospital like ours has several challenges that make it not to run well. I know that as a journalist, people must have complained to you about one thing or the other in the hospital. It is not because we are not aware or because we don’t want to do anything; it is because of the challenges we have and some challenges that government has.
I would like to commend the government for what they are doing. But I believe that things can get better and can only get better if government injects more money into the system. When you travel abroad and you see their hospitals, there is nothing that stops us from getting our hospitals to those standards. We can provide those services we see abroad and keep our environment clean.
And you believe that by doing so, people would trust our health sector more?
Yes. It is all about process. Because of such issues, we started the amenity ward for those who can afford it; to give them the ambience and services they need in order to reduce capital flight. Now, there is nobody to fund it due to economic downturn. So, what we are doing is to source partners through public/private partnership.
That is not to say that the health sector has not improved. The health sector in real sense has improved over time. Whether they like it or not, we cannot deny the fact that the health sector has improved. When you travel to other African countries for seminars and you meet your colleagues from those countries, you will know that Nigeria is far ahead of them. There was a programme under the then President Olusegun Obasanjo, where government took time to re-equip many of our teaching hospitals. Of course, UPTH was one of the beneficiaries. The government gave N2 billion to each of these hospitals and bought equipment and other things. That alone revolutionalised the health care system in Nigeria.
There is an improvement in our health sector, but the problem is that we have not got to where we should be. We want to get to where we would be compared to the hospitals in Europe, India and Israel. We have not got there, but we have made a lot of improvement.
What is the difference between our hospitals and the ones abroad?
The major difference is in terms of technology and equipment. Over there, their buildings and environments are clean. They have constant electricity and water supply. But here, we are struggling with the basic things. There is no water, no electricity, the hospital management struggle. And when you go to the hospital and you don’t see these basic things, you will not be happy. But abroad, they have gone beyond these challenges. We need money to acquire new technology and to train people to know how to use the equipment, and those things cost money. That is the difference.
We the Nigerian doctors, if we operate in those environment we are like super stars. Nigerian doctors are professionally qualified. Like here, we train doctors and that is our special mandate as a teaching hospital. In terms of manpower, we don’t have any problem.
The doctors in this hospital were fully involved in the fight against Ebola outbreak last year, and one of them was actually infected. Yet, some people believe that the outbreak was political. What really happened?
If anybody tells you that Ebola outbreak in Rivers State was political, that is a fallacy. The outbreak was real. We struggled over it to a level that one of our members was infected. She was treated and she survived. So, it was not political but real. I want to use this opportunity to commend the Federal Government and the state government for all the actions and leadership they showed during the Ebola outbreak. Ebola was like a war and all of us were involved as a nation.
The team from the Federal Government collaborated with the state government and they showed a lot of commitment. Former President Goodluck Jonathan and former Health Minister Prof. Onyebuchi Chukwu, showed a lot of commitment. The immediate past governor of Rivers State, Chibuike Amaechi, and former Commissioner for Health, Dr. Sampson Paker, also deserve commendation. So, there was a joining of forces from federal to state. The Federal Government sent a delegation that was joined by the state delegation with the assistance of foreign partners like Doctors Without Border, WHO and others. We constituted a team and, of course, most of the manpower came from this institution. With all hands on deck, we were able to defeat Ebola.
But a lot of people said the UPTH was not prepared for the task of tackling the outbreak of Ebola virus disease in Rivers State…
Ebola is a special kind of illness. Nigeria had not witnessed anything of that nature before. You remember that when it started in the West Africa sub-region, we thought it would not reach Nigeria. Then it landed in Lagos and everybody was shouting. Although we were preparing people, telling them what to do in case anything happened in Port Harcourt; don’t forget that it was when the outbreak occurred in Lagos that we started training our health workers on the precaution to take, because the most important thing about Ebola is prevention.
When eventually we had an index case in Port Harcourt, it was a big battle. And then the resident doctors were on strike. Some of our doctors happened to be treating the index case without knowing it. Remember a doctor who was practising in Rumuokoro became ill. The doctor who was running a private clinic was married to one of our doctors. Because the Rumuokoro doctor was our doctor, other doctors participated in his treatment. We have various specialists, so the doctors in this hospital were invited to manage the infected doctor, who is their colleague. Of course, they didn’t know it was Ebola, so they were all exposed. That was why we were in the thick of it. And when we realised that it was Ebola, it became a big war.
Again, we hosted the diagnostic lab for Ebola. In the initial cases, we were sending samples to Lagos, but later our own lab was set up. We were very seriously involved. Anybody who said we were not prepared, then I may not know what the person means by not being prepared. Because we were involved to the extent that we started producing our own hand sanitisers.
Although we didn’t have a lot of money, the sanitisers were produced according to the standard set by WHO. And during that period, many hospitals in town refused to take anybody who had a fever. They said it was Ebola. But because we are a government hospital, the apex hospital, we have to prepare to take anybody rejected by other clinics. These were some of our contributions during the outbreak.
What is your experience like when doctors are on strike at the point when their services are needed most?
Like today (June 10), I got a letter of indefinite strike from the Association of Resident Doctors, UPTH Branch. They said that by midnight, they will go on strike. But I know that I was in their meeting this morning talking to them not to go on strike. What I told them is that look, even if what you are asking for is your right, the timing is wrong. We just had a new government which has not settled down. And we are aware that our President is a gentle man, he is an action man, and his past record shows that he has a listening ear. He doesn’t tolerate anything that is wrong. This kind of President, if you tell him your problem and you convince him, he is definitely going to look into the problem. He is not a man who runs away from solving problems.
I have pleaded with them to give this government time to settle down. I am not supposed to be at their meeting but I had to go because this nation belongs to all of us. When there is strike and the place is shut down, everybody suffers, especially the innocent Nigerians who have no other place to go to.
All I am saying is that let them give this incoming government some time. The economy is bad. Despite that, the new government is a listening one. They are morally upright and I believe President Muhammadu Buhari and his team will solve their problem. But they need time to settle down.
People are complaining that most of the doctors who attend to patients at UPTH are student doctors. How true is this allegation?
Thank you for asking this question. One thing is that most people don’t understand how a teaching hospital runs. Many people are also ignorant of the categories of doctors that work in the teaching hospital. I think you are right, and as a journalist, you should educate the people.
Part of our medical mandate is to train medical manpower and not only doctors. That is why we have many training institutions here. But with regard to doctors, we do training for undergraduates and for post-graduates. Undergraduates are people who are in the university aspiring to have a degree in medicine. And that is why we are a teaching hospital. Those who are in the university as undergraduates are not yet doctors; they don’t have certificates. So if you want to call them student doctors, they are really student doctors and they are not allowed to treat any patient because they are learning. They can never treat patients because they are not licensed. They have consultants who are teaching them. The consultants are specialists and we have the highest concentration of specialists in the entire nation.
We have 170 consultants in this hospital. When a consultant or a resident doctor is treating a patient, the ones you called student doctors have the right to stay around and ask questions and observe. That is how we train them. Before they can do anything, they must be guided by the specialists. For you to treat a person, you must have a licence. If somebody who doesn’t have a licence treats a patient, that person is a quack.
Now, the mistake people make is that we also train post-graduate doctors. Doctors who have first degree, we train them to become specialists. The person can be an eye doctor, ear, bone and so on. And before you can be trained as a specialist, you must first of all qualify as a doctor. If you go to a private hospital or clinic out there and they are treating you, would you say they are student doctors? They have already qualified as doctors with many years of experience. Medicine is too large, and for you to practise, you have to specialise in one part of it. That is what makes that person a specialist.
At what point would a person in need of treatment be rejected by a hospital?
Well, it depends on information. We are a government hospital and government established this hospital to treat Nigerians. The people have a social contract with government, and the basic function of government is to protect life and property. Your life is your greatest possession, so government takes the maintenance of life very seriously. That is why the health sector is an essential service. You cannot be sending somebody to government hospital and you would be turned away. We are under oath from government not to reject anybody. We are the apex. If we reject a person, where do you want the person to go to?
What happened is that because we are a government hospital, we have a limited bed capacity. At some point in time, everywhere will be filled up. There is no time we are not oversubscribed. When it is filled up, if it is our labour or emergency ward and then you have a new person coming in, if you are in my shoe, what would you tell the person? We have a standard rule that when you come to the hospital, a doctor will evaluate you and talk to you. And if it is something that needs prescription, he will do that. But if after seeing you, it is something that you need to be admitted and everywhere is filled up, what do you want me to do? You will go and look for space elsewhere. We can then invite the person when we have space.
If a patient says he doesn’t have money to pay after treatment, as a government-owned hospital, how would you handle such matter?
We have many poor people in the society. That is why as a government-owned hospital, we try our best to make sure that service delivery does not shut down. That is the major reason I begged these doctors not to go on strike, because it is the ordinary Nigerian who would suffer, especially those who don’t have money.
Now, when people come to the hospital, the first concern is not money but to save life, especially in emergency. That is not to say that we don’t collect money. But the focus is not on money but to save life. However, to save life we need certain basic inputs. We need consumables to keep the hospital growing. What we charge people is discounted price because it is government people. Government pays the salary of everybody and all the buildings are owned and maintained by government. The amount of money that government is spending to run the hospital is much. Our salary bill is close to N500 million every month. If we ask people to be paying so that government can stop spending, many Nigerians cannot afford it.
The money people are paying here is cheaper than they pay in private hospitals. What surprises us is that even with this discounted fee, many Nigerians are unable to pay after you would have rendered some services. And when you say, ‘Pay your money,’ he or she would say, ‘I don’t have money.’ At that point, what we do is to appeal, begging them to link their parents or relatives. There are some difficult ones who would tell you that they don’t have anybody and the people that brought them to the hospital would run away.
We have also set up what we call an indigent patient fund so that the privileged ones can donate. When we have this kind of challenge, we can put hand into the indigent fund. But many Nigerians are not contributing to it. We go to churches and other organisations, asking them to contribute but the response is not the way it should be. But we have some catholic organisations that have been so faithful contributing to the fund.
There are funny situations where you have treated the person and he is unable to pay his bill. And when you have another person waiting to take over his bed, it becomes necessary that he pays to make space for another. We try our best that we don’t maltreat them. But at the same time, if you don’t accept money, the hospital will shut down. So, we try and make them see reasons through the help of the Medical Service Department.
It is also a specialist department. They know how to trace the family of the patient even if it means visiting their village to plead with them to see reason to pay something if they cannot afford the whole bill. One thing is certain, we cannot deny somebody treatment because he or she doesn’t have money. But because we have treated the person, he should pay something. This hospital is a common heritage for all Nigerians and everybody must contribute to maintain it.
Let me also use this opportunity to appeal to well-to-do Nigerians to help to contribute to the indigent patients’ fund. A hospital like this needs many things. We cannot continue to struggle. Companies should come here and contribute as part of their social corporate responsibility. Life is the greatest asset to possess. Once your health is poor, you cannot enjoy life any longer and you cannot equate anything with life.
